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Texas Widens Gap Over Other States in Percentage Uninsured

by Jeffrey M. Jones

No states show consistent decline in uninsured since 2008

PRINCETON, NJ -- Texas continues to be the state with the highest percentage of residents without health insurance. At 27.6%, its rate is more than four percentage points higher than the next highest state, Mississippi. This is the largest gap Gallup has measured between the first and second state since it began tracking health insurance in 2008.

Massachusetts remains the state with the lowest percentage of uninsured, at 4.9%. Vermont, Hawaii, Connecticut, Minnesota, and Wisconsin also have uninsured rates below 10%.

The four-point gap between Texas and Mississippi in 2011 exceeds gaps of less than three points between Texas and Mississippi in 2010 (27.7% vs. 24.8%) and 2008 (25.0% vs. 22.2%) and between Texas and Louisiana (27.0% vs. 23.5%) in 2009.

Nationwide, 17.1% of Americans lacked health insurance in 2011. These results are based on the Gallup-Healthways Well-Being Index for 2011, and are based on interviews with more than 350,000 U.S. residents throughout the year, which includes at least 1,000 residents in every state.

In general, the states with the lowest percentages of uninsured residents are concentrated in the east and upper Midwest, with Hawaii the lone exception. States with the highest proportions of residents lacking health insurance are in the southern and western parts of the country.

Little Change in Health Insurance Coverage by State

Massachusetts has ranked first and Texas last in each of the four years Gallup has measured health insurance coverage at the state level. Massachusetts' low rates are probably due to the health insurance reforms passed in that state in 2006 under then Governor Mitt Romney. The reasons for Texas' consistently high uninsured rates are less clear, although its large Hispanic population is likely one factor, as Gallup finds especially high rates of uninsured among U.S. Hispanics.

More broadly, the states with the lowest uninsured rates in 2011 have also been among the lowest every year since 2008. Six states -- Massachusetts, Vermont, Hawaii, Connecticut, Minnesota, and Pennsylvania -- have ranked in the top 10 lowest states each of the last four years, with Wisconsin and Maryland doing so three of the last four years.

Four states have ranked among the 10 with the highest percentage of uninsured residents every year since 2008, including Texas, Mississippi, Oklahoma, and Nevada. Florida, California, Arkansas, Georgia, New Mexico, and Louisiana have done so three of the last four years, with Louisiana finishing just outside the top 10 this year.

No States Show Measurable Decline in the Percentage of Residents Uninsured

Given the generally small size of year-to-year changes in insurance rates and the sampling error associated with these state-level estimates -- ranging from two to four points depending on the size of the state -- it is difficult to precisely measure short-term changes in health insurance rates. (For the full data on each state since 2008, see page two.)

One sign of a declining rate in the uninsured, though, would be a consistent, year-to-year decrease in the percentage of uninsured. No states have shown such a pattern since 2008, making it unclear if any state has made real progress in reducing the percentage of their residents lacking health insurance over the last four years.

Five states -- Rhode Island, Florida, California, New Jersey, and New York -- have shown measurable increases each year in the percentage of residents who are uninsured, suggesting that these states are showing a real increase in number of people who do not have health insurance. Massachusetts has also shown increases in uninsured rates each of the last four years, but these have been minimal each year and the total increase there since 2008 is less than a percentage point (from 4.2% to 4.9%).

Four years ago, Rhode Island and New Jersey were among the 10 states with the lowest percentage uninsured. But because of increases in the percentage of uninsured in these two states in recent years, they no longer hold that distinction, though their percentages of uninsured remain low compared with most other states.

Meanwhile, California and Florida have moved up among the states with the highest percentage of uninsured after being outside the top 10 in 2008.

Implications

Massachusetts and Texas continue to set the lower and higher ranges of uninsured residents by state. The relative rank order of the states has generally remained consistent from year to year, underscoring the general stability of these rates over time. Further, no states have shown a measurable decrease in the percentage of residents uninsured since 2008.

Nationally, more Americans have reported being uninsured each year since 2008, and a few states have followed that pattern.

One of the primary goals, if not the main goals, of the 2010 healthcare overhaul President Obama and the Democrats in Congress passed was to reduce the percentage of uninsured Americans nationwide. The law is still trying to survive legal challenges, which the U.S. Supreme Court is hearing later this month.

If it survives all the legal challenges, the healthcare law will be mostly implemented by 2014, and its ultimate success in achieving its goals will be apparent in the percentage of uninsured Americans from that point forward.

Gallup's "State of the States" series reveals state-by-state differences on political, economic, and wellbeing measures Gallup tracks each day. New stories based on full-year 2011 data will be released throughout the month of February.

Survey Methods

Results are based on telephone interviews conducted as part of the Gallup-Healthways Well-Being Index survey Jan. 1-Dec. 31, 2011, with a random sample of 353,492 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia, selected using random-digit-dial sampling.

For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±1 percentage point.

Margins of error for individual states are no greater than ±4 percentage points and are ±3 percentage points in most states.

Interviews are conducted with respondents on landline telephones and cellular phones, with interviews conducted in Spanish for respondents who are primarily Spanish-speaking. Each sample includes a minimum quota of 400 cell phone respondents and 600 landline respondents per 1,000 national adults, with additional minimum quotas among landline respondents by region. Landline telephone numbers are chosen at random among listed telephone numbers. Cell phone numbers are selected using random-digit-dial methods. Landline respondents are chosen at random within each household on the basis of which member had the most recent birthday.

Samples are weighted by gender, age, race, Hispanic ethnicity, education, region, adults in the household, and phone status (cell phone only/landline only/both, cell phone mostly, and having an unlisted landline number). Demographic weighting targets are based on the March 2010 Current Population Survey figures for the aged 18 and older non-institutionalized population living in U.S. telephone households. All reported margins of sampling error include the computed design effects for weighting and sample design.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

For more details on Gallup's polling methodology, visit www.gallup.com.

Slightly more Americans agree (52%) than disagree (45%) that the federal government is responsible for making sure all Americans have healthcare coverage. This balance of views is similar to last year.

Americans' daily self-reports of spending averaged $98 in November, up from $93 in October. The latest figure is the highest average recorded for the month of November since Gallup began tracking consumer spending in 2008.

Americans are now almost evenly split on whether to amend the U.S. Constitution to replace the Electoral College with a popular vote system for electing presidents. In the past, Americans preferred the popular vote.